Deaths from cardiovascular disease involving anticoagulants: a systematic synthesis of coroners' case reports to prevent future deaths
Ains A., Heneghan C., Aronson JK., DeVito NJ., Richards GC.
Background: The global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents. Objective: To identify CVD-related PFD reports highlighting the use or lack of anticoagulants as having caused or contributed to deaths. Methods: We conducted a retrospective observational study of coronial case reports in England and Wales between 2013 and 2019. We screened 3037 PFDs for inclusion and used content analysis to assess concerns raised by coroners and who responded to them. Results: We identified 113 CVD-related PFDs (113 deaths) involving anticoagulants. Warfarin (36%), enoxaparin (11%), and rivaroxaban (11%) were the most common anticoagulants reported. In 14 cases, the coroner mentioned that the administration of an anticoagulant may have prevented the death. Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%). These concerns were most often directed to NHS trusts (29%), hospitals (10%), and general practices (8%), but had national importance. Nearly two-thirds (60%) of PFDs had not received responses from such organisations, which are mandatory under regulation 28 of the Coroners' (Investigations) Regulations 2013. Conclusions: We created a tool (https://preventabledeathstracker.net/) that bring together coroner reports to identify important lessons related to preventable deaths. Here we examined instances of premature deaths from CVD involving anticoagulants. National organisations, healthcare professionals, and prescribers should take actions to address these concerns, to improve the use of anticoagulants in patients with CVD.